Category Archives: Uncategorised

Case 149- summary

This weeks case focussed on the importance frailty assessment in making treatment decisions for an elderly patient with Diffuse large B cell lymphoma. This is an important topic as DLBCL affects an older population with mean age at diagnosis of … Continue reading

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Case 149 – Update 1

  Our patient is a retired cleaner who lives in a house next to her only daughter and her two grand-children. She is a non smoker and drinks no alcohol. She tells you that her daughter tended to do the … Continue reading

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Case 149 – The Beginning

You are the on call haematology registrar working at a District general hospital when you receive a call from the medical team at 4pm on a friday. They have an 87 year old lady with neck lymphadenopathy that has grown … Continue reading

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Case 148 conclusion and summary

The patient is treated for serum sickness. Given the severity of the symptoms, he is given another pulse of methylprednisolone and converted back to oral prednisolone. He is also treated supportively with analgesia and antipyretics, as well as platelet transfusions. … Continue reading

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Case 148: update 3

HLA typing of this patient’s two siblings has not identified a match. Unfortunately, unrelated donor search has not identified any suitable donors. The patient is consented to immunosuppressive therapy with horse ATG and ciclosporin. The patient is admitted and receives … Continue reading

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Case 148: update 2

The patient is admitted for broad spectrum antibiotics and red cell transfusion. A bone marrow biopsy is performed, which demonstrates 10% cellularity with no dysplastic features, no excess of blasts, no abnormal infiltrate and no fibrosis. Cytogenetics demonstrate a normal … Continue reading

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Case 148: update 1

The gastroenterology team have kindly organised further investigations. B12 and folate are normal, viral serology (including HIV, CMV, EBV and parvovirus) are all negative. Autoantibody screen was also negative. LDH is normal and there is no evidence of haemolysis. Peripheral … Continue reading

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Case 148: the beginning

You are the liaison haematology registrar and receive a call from the gastroenterology team for advice about a 24 year old male patient under their care. He is a previously fit and well university student who initially presented 3 months … Continue reading

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Case 147 summary: VITT

Many thanks for following our case this week of a young patient with VITT – a syndrome which emerged in Spring 2021 and offered significant challenges to treat Following extensive roll-out of vaccines to protect against SARS-CoV-2, concerns arose around … Continue reading

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Case 147 – Update 3

Our 34 year-old female patient with VITT has responded well to plasma exchange, IVIg and anticoagulation and is now in neuro-rehabilitation with a normal FBC and is due to be discharged. The rehab medicine team wish to have your advice … Continue reading

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Case 147 – Update 2

We have a 34 year-old female patient presenting with headache, thrombocytopenia (plt 25) and intracranial haemorrhage requiring a decompressive craniectomy. She had the ChAdOx1 nCoV-19 (AstraZeneca) vaccine 13 days ago. D-dimers are significantly elevated at 35,283 and subsequent CT venogram … Continue reading

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Case 147 – Update 1

We have a 34 year-old female patient who has presented with headache, thrombocytopenia (plt 25) and intracranial haemorrhage requiring a decompressive craniectomy which was supported with 2 pools of platelets pre-operatively and a further pool intra-operatively. She is now on … Continue reading

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Case 147 – the beginning

It is 4am and you are peacefully dreaming about the educational opportunities at #BBTS2021 when you are awoken by the neurosurgical SpR on-call. They would like advice around product support for a patient they wish to take to theatre for … Continue reading

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Case 145 – summary

Antiphospholipid syndrome (APS) is an acquired autoimmune disease characterised by laboratory criteria (persistent antiphospholipid antibodies) and clinical criteria (venous/arterial/micro-thromboses and/or pregnancy morbidity). Catastrophic antiphospholipid syndrome (CAPS) is a rare manifestation of APS, which is characterised by rapid onset of multi-organ … Continue reading

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Case 146 – summary

Marginal zone lymphoma is a type of low grade B-cell non-Hodgkin lymphoma. It can be sub-classified as nodal, splenic, and extra-nodal (EMZL) of mucosa-associated lymphoid tissue (MALT). They make up 5-15% of all non-Hodgkin lymphomas in the Western world. EMZL … Continue reading

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Case 146 – update 4

Our patient undergoes involved-field radiotherapy to her stomach and perigastric lymph nodes with good clinical and radiological results – however, her surveillance biopsies remain positive for residual lymphoma. As she is asymptomatic, she resumes a watchful waiting approach. After 9 … Continue reading

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Case 146 – update 5

Repeat CT scanning at this point shows recurrence of this lady’s perigastric lymphadenopathy, as well as bilateral neck and left axillary nodes. She is commenced on systemic treatment with rituximab and chlorambucil, which she tolerates well without major side effects. … Continue reading

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Case 146 – update 3

This lady has had a partial response after eradication therapy but is asymptomatic, so continues active monitoring with 3-monthly OGDs. After about 12 months, she becomes symptomatic again with abdominal discomfort. CT scanning shows gastric wall thickening and perigastric lymphadenopathy … Continue reading

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Case 146 – update 2

This lady has been diagnosed with stage IE extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), Helicobater pylori positive. She has completed 4 weeks of triple eradication therapy with lansoprazole, amoxicillin and clarithromycin, and her H. pylori test … Continue reading

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Case 146 – update 1

You have arranged for this lady to have a CT chest/abdomen/pelvis which, apart from thickening of the stomach lining, is unremarkable. Her final biopsy results are reported as follows: “There is a diffuse atypical lymphoid infiltrate of medium sized cells … Continue reading

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